Cranial osteopathic treatment and stress-related effects on autonomic nervous system measured by salivary markers: A pilot study.

BACKGROUND: Variations in the concentration of salivary alpha amylase (sAA) may indicate a change in the autonomic nervous system functionality. In osteopathic medicine it has long been stated that the osteopathic manipulative treatment (OMT) can modulate the autonomic nervous system. Studies carried out on the compression of the fourth ventricle (CV4) have shown a positive effect in reducing the sympathetic tone. The goal of this pilot study is measuring the physiological response of the sAA levels after CV4 technique. METHODS: 90 subjects were randomly assigned to a sham, a control or a CV4 group. Randomization accounted for sex and score in the STAI-2 (form Y) questionnaire. Each subject completed the STAI-1 (form Y) questionnaire to evaluate the anxiety of the moment. sAA activity and saliva flow rate were measured. Saliva was collected before, immediately after and 30 min after treatment. RESULTS: Within group analysis revealed that sAA activity increased significantly immediately after the technique application only in the CV4 group (p = 0,05). Between groups analysis show a significant difference of the sAA activity in the CV4 group respect the control group (p < 0,05), but no significant difference between CV4 and sham group (p > 0,05). The effect in the CV4 group after the intervention is highly variable and appeared to be related to the level of stress measured with the STAI-Y1 questionnaire (p = 0,002). CONCLUSIONS: This study shows a positive effect of the CV4 procedure on sAA activity even if not significantly different from the sham procedure, probably due to the confounding effect of stress variability between groups.

Three-dimensional sonograph of a monochorionic diamniotic triplet pregnancy.

A monochorionic diamniotic triplet pregnancy was diagnosed by sonographic scan at 9 weeks of gestation. The three embryos appeared to share the same trophoblast, with two of them sharing the same amniotic sac. The two amniotic sacs were divided by a thin membrane, with no chorionic projection within it, and each amniotic sac presented a single yolk sac. Only few cases of nontrichorionic-triamniotic triplets have been reported in the literature. Although the diagnosis was reached using the two-dimensional ultrasound, the complementary use of three-dimensional ultrasound helped in confirming the diagnosis, and in offering the couple an adequate counseling.

[The role of the occupational physician in the assessment of accident risk]. / Il ruolo del medico competente nella valutazione del rischio infortunistico.

The prevention of accidents at work in Italy is a target still to be reached for the safety of workers in workplaces, despite the innovative provisions introduced by the Legislative Decree 81/08 and the decrease of the number of total and fatal accidents occurred in the period 2001-2008, as reported in the statistics of the Italian Workers' Compensation Authority (INAIL). The occupational physician performs a very important role in the accident risk assessment, based on his biomedical and ergonomic knowledge. His role is carried out during the phase of safety risk assessment, contributing to assess plants, machines, tools, personal protective equipments, to be used by the workers. His knowledge of the health status of workers, acquired by medical surveillance and aimed to prevent accidents by providing the fitness for work evaluation in relation to the presence of diabetes mellitus, musculoskeletal diseases, sleep disorders, or to the assumption of hypnotic drugs, when the employee works at height or as driver such as in the transport or construction industry, is not less important. Unfortunately, this latter role of the occupational physician is limited because the Italian Safety Legislation does not provide for the sanitary surveillance of all the workers employed in factories.

Preparation of feeding obturators for newborns with cleft palate: clinical and laboratory procedures.

The clinical and laboratory procedures for fabricating a neonatal feeding obturator requiring only a single impression followed by relining of the plate are described. The technique involves the use of a specific custom tray and polysiloxane putty for the impression, autopolymerizing acrylic resin for the plate, and a soft liner for the relining procedure. In over a decade, an obturator plate applied with this technique in 81 newborns with cleft palate has obtained good nutritional and functional results.

Magnetic resonance imaging of temporomandibular disorders: classification, prevalence and interpretation of disc displacement and deformation.

AIM: To analyse the prevalence of disc displacements and deformations from MRI of symptomatic temporomandibular disorders (TMD). METHODS: The study was conducted retrospectively on 192 joints of 98 patients (67 females, 31 males, mean age 29 years), who had undergone bilateral MRI (except for four who had unilateral) in the sagittal (both open and closed mouth) and coronal (closed mouth only) planes. These displacements were subdivided into static (complete anterior and posterior, partial anterolateral and anteromedial, sideways lateral and medial, anterolateral and anteromedial rotational) and dynamic (with reduction, without reduction, with incomplete reduction; non-determinable). Disc deformations were subdivided into: enlargement of the posterior band, reversed biconcave shape, biplanar (flattened) and biconvex shape. RESULTS: Eighty per cent of patients had bilateral displacement, 15% unilateral and 5% a normally positioned disc. Complete anterior displacement was the commonest and sideways the rarest. Reduction was present in 58% of disc displacements, no reduction in 26%, incomplete reduction in 4%, while in the remaining 12%, it could not be determined. Rotational displacement was the most likely to feature reduction and sideways the least. Temporomandibular joints with no reduction were closely correlated with bone lesions. The most frequent deformation was biplanar and the rarest enlargement of the posterior band. CONCLUSIONS: There was a high prevalence of displacements and deformations. While they do not appear to be significant in inducing pain, they can predispose to the onset of osteoarthrosis.

Can transvaginal fetal biometry be considered a useful tool for early detection of skeletal dysplasias in high-risk patients?

OBJECTIVE: To evaluate the possibility of an early diagnosis of skeletal dysplasias in high-risk patients. METHODS: A total of 149 consecutive, uncomplicated singleton pregnancies at 9-13 weeks' amenorrhea, with certain menstrual history and regular cycles, were investigated with transvaginal ultrasound to establish the relationship between femur length and menstrual age, biparietal diameter and crown-rump length, using a polynomial regression model. A further eight patients with previous skeletal dysplasias in a total of 13 pregnancies were evaluated with serial examinations every 2 weeks from 10-11 weeks. RESULTS: A significant correlation between femur length and crown-rump length and biparietal diameter was found, whereas none was observed between femur length and menstrual age. Of the five cases with skeletal dysplasias, only two (one with recurrent osteogenesis imperfecta and one with recurrent achondrogenesis) were diagnosed in the first trimester. CONCLUSIONS: An early evaluation of fetal morphology in conjunction with the use of biometric charts of femur length against crown-rump length and femur length against biparietal diameter may be crucial for early diagnosis of severe skeletal dysplasias. By contrast, in less severe cases, biometric evaluation appears to be of no value for diagnosis.

[Morphological and positional changes in the disk after nonsurgical therapy. The MRI documentation and clinical correlations]. / I mutamenti morfologici e posizionali del disco dopo terapia non chirurgica. Documentazione in RMN e correlazioni cliniche.

AIMS: To evaluate the position and shape of the disc using MNR before and after non-surgical therapy and to correlate MNR findings with other signs and symptoms. METHODS: MNR imaging of 26 joints belonging to a selected sample of 13 patients (7 F, 6 M, mean age 27 years) with signs and symptoms were compared with MNR performed after a period of non-surgical treatment that included a combination of splint therapy, psychoeducational advice, drugs and physiotherapeutic aids, including manipulation. The criteria for selection were monolateral symptoms and bilateral nature at the initial NMR showing reducible and non-reducible dislocation not associated with degenerative changes and/or effusion. The interval between diagnostic NMR and control imaging was approximately 12 months. The interval between splint application and control NMR was approximately 8 months. NMR included a sagittal study with the mouth open and shut and a coronal study only with the mouth shut using 3 mm-wide cuts. Post-therapy RMN was performed without the splint in position. RESULTS: The comparison between NMR images showed that 17 of the 26 joints studied had a stationary pathological situation and 9 were in evolution. In spite of these pathological NMR images, the signs and symptoms were found to have regressed or improved. CONCLUSIONS: These findings can be interpreted in two ways: the disc dislocation and deformation are compatible with the lack of signs and symptoms, or many dislocations should be regarded as an anatomical variation rather than an abnormality.

[Dental anomalies in some hereditary syndromes observed by the authors]. / Contributo sulle anomalie dentali in alcune sindromi ereditarie di personale osservazione.

BACKGROUND: The ectodermal hypohidrotic dysplasia, Marfan and Robinson syndromes are hereditary syndromes. They are characterized by teeth anomalies associated with system anomalies. The purpose of the present study is an analysis of single dental anomaly cases in personally observed syndromes. METHODS: The dental arch radiographs of 8 patients suffering from hereditary syndromes characterized by teeth anomalies have been studied. These dental anomalies have been classified--from an anatomic-clinical viewpoint--as to number (missing/exceeding teeth), shape, position, volume (too much/too little), eruption (early/late, till inclusion) and structure (enamel, dentine, cement). For each syndrome, the kind of transmission, the kind of dental anomaly (isolated or associated), the prevailing, the kind of association among the various dental anomalies have been evaluated. CONCLUSIONS: The most frequently observed anomaly among the examined syndromes has been the number associated to shape. The 95.4% of the specimen presented association between different dental anomalies. The results of the observation confirm the well documented ontogenetic and etiopathogenetic relationship between genetics, dental genesis, morphogenesis, teeth eruption and growth. Dental anomalies observation should direct the surgeon towards considering the presence of other signs and symptoms when tracing out probable and more complex--sometimes recessive--syndrome outlines.

[2 rare cases of agenesis of the second molar among blood relations. A clinical contribution]. / Due rari casi di agenesia del secondo molare tra consanguinei. Contributo clinico.

Teeth agenesis is an anomaly of frequent observation with a familiar heredity transmission pattern. In a frequency order the most common agenetic teeth are: third molars, upper lateral incisors and second lower bicuspids. Of exceptional rarity is the absence of second molars. Our observation confirm the heredity pattern of congenitally missing permanent teeth; in this case anomaly showed variable expressivity and different degree of severity.

Prenatal diagnosis of microcephaly assisted by vaginal sonography and power Doppler.

In two mid-trimester fetuses with microcephaly, transvaginal sonography revealed aberrant findings, including large subarachnoid spaces and a rudimentary shape of the lateral ventricles. In one of these fetuses, power Doppler ultrasound demonstrated a discrepancy in the size of the signals generated by the intracranial arteries branching from the internal carotids and those branching from the vertebral arteries, and this was interpreted as the consequence of a reduced blood supply to the undersized cerebral hemispheres. We suggest that evaluation of intracranial anatomy by transvaginal sonography and power Doppler examination of the cerebral vessels may be of value in the diagnosis of fetal microcephaly.

Percutaneous umbilical blood sampling in the management of immune thrombocytopenic purpura during pregnancy.

Severe neonatal thrombocytopenia occurs in about 15% of deliveries from women with immune thrombocytopenic purpura (ITP). Conflicting data exist about the real usefulness of percutaneous umbilical blood sampling (PUBS) in evaluating the fetal platelet count. We report successful experience, using PUBS, in the management of 12 pregnant women with ITP.

A series of 17 cases of congenital cystic adenomatoid malformation of the lung: management and outcome.

During a 5-year-period, 17 cases of congenital adenomatoid malformation of the lung were observed in the Department of Pediatric Surgery of Bologna University-S. Orsola-Malpighi Hospital; 16 cases were diagnosed in utero by ultra-sound. 13 patients had prenatal diagnosis between 21 and 23 weeks of gestation; 2 cases were diagnosed at 25 weeks and another one at 26 weeks. The other case came from another hospital, and the diagnosis was accidentally detected postnatally. In 3 cases the parents decided to terminate the pregnancy 3 cases had spontaneous improvement during the last weeks of gestation, and were perfectly normal at birth. One case was lost to follow-up; all remaining patients underwent resection. Among these patients only one was a nonsurvivor, while 9 have completely recovered. However, one patient developed persistent pulmonary hypertension, which could successfully be treated with drugs, another underwent laser treatment for laryngeal stenosis due to intubation. A special epidemiological information: 13 out 17 cases (76.5%) were female.

["Odontogenic" anxiety. A study of a population of 1500 students from the public schools in the Bari area]. / L'ansia "odontogena". Indagine in una popolazione di 1500 studenti di alcune Scuole pubbliche del Territorio Barese.

The authors have carried out a survey regarding 1500 students whose age ranged from 9 to 18 years. They belonged to some public schools of Gioia del Colle, a small town near the city of Bari. The aim of the study was to evaluate the dentist fear, the levels of anxiety and the main reasons or situations which can cause it. A questionnaire has been used for this purpose: the Dental Subscale Test. Results have shown that the 38.7% of the people questioned, has asserted to be afraid of the dentist and that this fear is much more felt in women than in men. Moreover has been demonstrated that this fear overcomes amongst those who have never undergone a dental treatment and that the degree of anxiety decreases from childhood to adulthood. In addition statistics analysis have proved that the sensation of choking, the sight and the sound of surgical instruments such as the drill and the fear of injections, are amongst those items which can be referred as the most frequent sources of anxiety for both males and females.

Transvaginal sonography vs. hysteroscopy in the preoperative staging of endometrial carcinoma.

The aim of this study was to evaluate the diagnostic accuracy of transvaginal sonography vs. hysteroscopy in the preoperative staging of endometrial carcinoma, in order to establish the most appropriate surgical therapy. Transvaginal sonography and hysteroscopy were used preoperatively in 67 women with histologically proven endometrial carcinoma. Deep myometrial invasion (> 50%) was present at postoperative pathology in 26/67 (39%) women and spread to the cervix occurred in 11/67 (16%) women. Transvaginal sonographic examination was initially directed at assessing myometrial invasion, which was correctly predicted in 52/67 (78%) women. Transvaginal sonography demonstrated a sensitivity of 88% (23/26) and a specificity of 71% (29/41) for deep invasion, with a positive predictive value (PPV) of 66% (23/35) and a negative predictive value (NPV) of 91% (29/32). The accuracy of transvaginal sonography in detecting cervical involvement was 82% (55/67), and that of hysteroscopy was 72% (48/67): transvaginal sonography was slightly less sensitive (54% vs. 64%), but more specific (87% vs. 73%) than hysteroscopy. When cervical invasion was present, the PPVs of transvaginal sonography and hysteroscopy were 46% (6/13) and 32% (7/22), respectively, while the NPV was 91% for both techniques (49/54; 41/45). Our data show that the accuracy of transvaginal sonography was comparable with that of hysteroscopy in detecting cervical involvement. Therefore, in the majority of cases, when both techniques showed that disease was limited, the appropriately limited type of surgery would be performed. Conversely, detection of a myometrial invasion of > 50% or an extension to the cervix would lead to an unnecessarily extensive operation if this was the sole criterion used for making the decision.

Successful treatment of essential thrombocythemia in a pregnancy with recombinant interferon-alpha 2a.

Essential thrombocythemia (ET) in pregnancy is associated with adverse perinatal outcome, which is likely due to thrombosis of the uteroplacental circulation. Obstetrical management is still controversial. Different therapeutic protocols have been adopted, including the use of aspirin, plateletpheresis, and interferon. We herein report a case of ET treated with interferon-2 alpha from 13 weeks gestation until term. Therapy was well tolerated, leading to a linear reduction of platelet and white blood cell count that rapidly returned within normal limits. A healthy, 3,020-g male infant was delivered at 40 weeks gestation. Albeit further experience is required, recombinant interferon-alpha 2a may play an important role in preventing complications in pregnant patients with ET.

Sonography of pregnancies with first-trimester bleeding and a viable embryo: a study of prognostic indicators by logistic regression analysis.

The objective of our study was to investigate the relationship between sonographic findings and the occurrence of abortion in pregnancies complicated by first-trimester bleeding in which fetal cardiac activity was documented upon admission. A prospective study of transvaginal sonography was performed in 270 pregnant patients with bleeding between 5 and 12 weeks' gestation. The study group included 149 cases in which a singleton fetus with cardiac activity was initially documented. The outcome variable was pregnancy loss prior to 20 weeks. The influence of sonographic findings on admission was studied by univariate analysis and logistic regression. The prevalence of abortion was 23/149 (15%). A significant relationship (p < 0.05) was found between the occurrence of abortion and the following: fetal bradycardia (heart rate less than -1.2 SD from the mean), a discrepancy between the diameter of the gestational sac and crown-rump length less than -0.5 SD from the mean, and a discrepancy between menstrual and sonographic age of more than 1 week. According to the logistic regression equation that was obtained, the probability of abortion in first-trimester bleeding with documented fetal cardiac activity upon admission varied between a minimum of 6% when none of the above risk factors were present and a maximum of 84% when all were present. The presence of any of the above factors identified 84% of all subsequent abortions.

Accuracy of transvaginal ultrasound and serum hCG in the diagnosis of ectopic pregnancy.

Transvaginal ultrasound was performed upon admission of 127 patients with a clinical suspicion of ectopic pregnancy in association with human chorionic gonadotropin (hCG) determination. Failure to visualize with sonography an intrauterine gestational sac with an hCG level superior to 1000 mIU/ml identified 25/42 tubal pregnancies with a positive predictive value of 86% and a specificity of 93%. Abnormal adnexal findings occurred in 95% of the ectopic pregnancies. Extrauterine gestational sacs with or without embryos could be confidently detected in 19 ectopic pregnancies (45%). A complex adnexal mass was seen in 19 cases and yielded a positive predictive value of 90% (19/21). Adnexal gestational sacs and complex masses were seen more frequently in those ectopic pregnancies with an hCG level above 1000 mIU/ml but the difference was not significant (100% versus 78%). Simple adnexal cysts were found more frequently in intrauterine pregnancies, and fluid in the cul-de-sac was also not indicative of ectopic pregnancy (positive predictive value, 29%). Transvaginal ultrasound has a primary role in the diagnosis of ectopic pregnancy. The combined use of uterine and adnexal sonography associated with elevated hCG levels allows a definitive diagnosis in the vast majority of cases at a very early stage, when the chances for a successful conservative treatment are greater.

[A bacteriological study of supragingival bacterial plaque in subjects undergoing orthodontic therapy]. / Studio batteriologico della placca batterica sopragengivale in soggetti sottoposti a terapia ortodontica.

Direct contact between tooth enamel and bacteria is currently considered a sine qua non of tooth decay. Any condition which encourages the deposit and accumulation of bacterial plaque represents a risk factor for tooth decay. Dental therapy often entails the use of bands or brackets which house metal apparatus used to apply force or support mobile devices (plates, etc.). It is therefore possible to hypothesise that, by preventing its mechanical removal, dental treatment can lead to quantitative and qualitative changes in bacterial plaque.

[Dentinal lesions caused by the use of endodontic posts]. / Lesioni dentinali causate dall'impiego di alcuni endoposts.

An endodontic treatment has been effected on 36 extracted teeth, using drills; certain endodontic posts presently on the market have been successively inserted inside 18 teeth: Flexipost (Essential Dental System); Parapost Plus (Whaledent); dentatus (Dentatus). The teeth have been sectionized and watched through a photomicroscope to check an eventual presence of dentinal damages.

[The polymerization exothermicity of self-curing resins. Thermal measurements in the pulp chamber]. / L'esotermia di polimerizzazione delle resine autoindurenti. Misurazioni termiche in camera pulpare.

The study first assessed the influence of the quantity of resin and the type of matrix on exothermic polymerisation of self-curing resins. The temperature in vitro inside the pulp chamber was then measured during the preparation of a provisional single and multiple sample using different matrices; samples were prepared using a direct technique.